Researchers have found that aspirin use is associated with a decreased risk of developing a type of liver cancer, hepatocellular carcinoma, and death from chronic liver disease (CLD). The information was published on Medline Plus on Nov. 30, accompanying the publication of the study results in the medical journal entitled Journal of the National Cancer Institute.

Aspirin users had a 41% reduction in the risk of liver cancer and a 45% reduction in the risk of death from chronic liver disease, when compared to people who did not use aspirin or non-steroidal anti-inflammatory drugs or NSAIDs according to the recently published observational data, analysed from over 300,000 people aged between 51 and 70 who were enrolled in the National Institutes of Health-AARP Diet and Health Study who were followed up for between 10 and 12 years. People who took other types of NSAIDs had a 26% lower chance of dying from chronic liver disease, but no reduction in the risk of liver cancer according to the study.

Aspirin has long been known to reduce the risk of heart attack, stroke and deep vein thrombosis by thinning the blood, thus helping to prevent dangerous clots from forming which then travel up to the coronary arteries causing a heart attack.

Aspirin has also been studied with some positive results in relation to its ability to reduce the risk of colorectal cancer by up to 60% with the researchers finding that “600 mg aspirin per day for a mean of 25 months substantially reduced cancer incidence after 55.7 months (over four and a half years) in carriers of hereditary colorectal cancer.

Aspirin may also provide a small reduction in risk (16%) for estrogen receptor positive forms of breast cancer. A reduction in the risk of oesophageal, gastric and biliary cancers has also been noted in several studies previously, as well as a reduction in cancers which metastasised to distant sites.

People who take aspirin daily have a 36% lower likelihood of developing metastatic cancer, according to a meta-analysis published earlier this year.

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, occurring mainly among patients with CLD. Previous reports have linked the chronic inflammation which is caused by CLD to cellular processes that could promote the development of cancer cells.

Because aspirin and NSAIDs have anti-inflammatory properties and are widely used to prevent heart attack and stroke, nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin are being investigated as cancer chemopreventive agents.

What they found was that the use of NSAIDs was clearly associated with a reduced risk of HCC and a reduced risk of death from CLD compared to non-users. Study participants who used aspirin had a 41% reduced risk of HCC and a 45% reduced risk of death from CLD, whereas those who used non-aspirin NSAIDs experienced a 26% reduced risk of CLD mortality but no reduced risk of HCC.

The researchers adjusted for age, sex, race/ethnicity, cigarette smoking, alcohol consumption, diabetes and body mass index.

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Chronic liver disease and primary liver cancer, or cancer which develops first in the liver, are most frequently caused by hepatitis B and C virus infections and excessive alcohol consumption. There is also some evidence of a link between obesity and diabetes and the development of chronic liver disease through high insulin levels and non-alcoholic fatty liver disease.

Although the current study results are promising, these significant causative factors do not go away by popping an aspirin each day. Alcohol abuse and obesity are complex and multifactorial challenges that require interventions which encompass the psychology of the person as well as their physiology.

The study authors conclude that although we should study the potential of new chemopreventive strategies such as NSAID use, we should also continue to focus on improving the established practices and interventions, such as reducing these well-known risk factors.

A word of caution, however, should be noted, in that not all people with liver disease may benefit from preventative therapy with aspirin or NSAIDs.

“The higher-risk population for whom preventive strategies are needed — those with cirrhosis — likely wouldn’t be good candidates either because they are also at higher risk of bleeding,”
said Mary Ann Huang, MD, a hepatologist at Henry Ford Hospital in Detroit in an interview with MedPage Today.

Aspirin, or acetylsalicylic acid by its chemical name, is a well-established and relatively safe drug, having been first isolated in 1897, and previously used for 3000 years as the tea made from boiling the bark of the white willow, which contains salicylic acid. It is one of the most widely used medications in the world, with an estimated 40,000 tonnes being consumed each year.

It does, however, have some risks. It thins the blood and can increase bleeding and the risk of stomach ulcers, gastro-intestinal bleeding and even tinnitus at high doses.

The incidence of liver cancer in the general population is already very low, however, so the risks of taking aspirin to ward the disease off far outweigh the risk of the actual disease in people who are not already at increased risk of developing liver cancer or chronic liver disease. According to the National Cancer Institute, in 2012, there were less than 29,000 new cases of liver and intrahepatic bile duct cancer diagnosed in the United States and only 20,550 deaths.

The most effective time of day to take aspirin for the prevention of heart attack, stroke and deep vein thrombosis is at night. The blood is thickest and stickiest in the morning when you wake up, your circulation is also usually at its lowest so your risk of developing a clot from the blood moving so slowly and those sticky red blood cells bumping into one another and forming a clot, is greatest. This is why a quarter of heart attacks occur within three hours of waking up in the morning. If you take aspirin at night, your blood will not get quite as thick overnight and your risk of developing a dangerous clot will be reduced. For most people, an appropriate preventative dose is around half a regular aspirin tablet or 150-160 mg. You can also get the same amount from two baby aspirin tablets which contain 81 mg each.

Sources:

Sahasrabuddhe VV, Gunja MZ, Graubard BI, Trabert B, Schwartz LM, Park Y, Hollenbeck AR, Freedman ND, & McGlynn KA. (2012) Nonsteroidal Anti-inflammatory Drug Use, Chronic Liver Disease, and Hepatocellular Carcinoma. Journal of the National Cancer Institute. PMID: 23197492

Algra AM, & Rothwell PM. (2012) Effects of regular aspirin on long-term cancer incidence and metastasis: a systematic comparison of evidence from observational studies versus randomised trials. The lancet oncology, 13(5), 518-27. PMID: 22440112

Rothwell PM, Price JF, Fowkes FG, Zanchetti A, Roncaglioni MC, Tognoni G, Lee R, Belch JF, Wilson M, Mehta Z…. (2012) Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials. Lancet, 379(9826), 1602-12. PMID: 22440946

http://www.cancer.gov/cancertopics/types/liver

Warner, T. D.; Warner TD, Mitchell JA (2002).”Cyclooxygenase-3 (COX-3): filling in the gaps toward a COX continuum?”. Proc Natl Acad Sci USA 99 (21): 13371–3. doi:10.1073/pnas.222543099. PMC 129677.PMID 12374850.